Provider Demographics
NPI:1013994565
Name:HALLEY, JOAN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:E
Last Name:HALLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:#220
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-851-5121
Mailing Address - Fax:253-851-3059
Practice Address - Street 1:4700 POINT FOSDICK DR STE 220
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-851-5121
Practice Address - Fax:253-851-3059
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8308769Medicaid
WA1047105Medicare ID - Type Unspecified
WA8308769Medicaid